Abstract For the first time, it is possible to directly visualize a radiation beam hitting a patient's tissue or high resolution imaging of radiation delivery in water tank phantoms, using Cherenkov emission imaging. This allows the opportunity to do pre-treatment verification at high resolution, with real time video of a test phantom, prior to delivery to the patient. Radiotherapy has a diverse and increasingly complex number of delivery systems, yet independent verification of these remains a time-intensive challenge for the medical physics support team. Typically verification is only really utilized for the most complex stereotactic cases, where high resolution and small beam sizes are critical. Yet these are exactly the situations where current tools to verify the plan have limits. In order to not to overburden the system, verification tools must get better, faster and more accurate. The competing technologies using ionization chambers or diode arrays which largely are low spatial resolution devices or low temporal resolution, depending upon the configuration. A recent discovery that gated intensified imaging allows video-rate detection of Cherenkov emission during radiation therapy has opened up a new important paradigm in radiation oncology. This work has been invented and patented at Dartmouth, and exclusively licensed to DoseOptics LLC, a spin-off of this research program with the goal to advance video-rate Cerenkov imaging as a dose delivery imaging tool. The alpha prototype developed in this first phase 1 application showed that a low cost system could be prototyped for IMRT/VMAT verification in water tank imaging, called C- Verify. The C-Verify system will be further produced into a handful of Beta units which will be tested at partner academic medical center, as well as within an MRI-guided radiotherapy unit. The system will achieve video-rate capture of IMRT/VMAT data at sub-millimeter spatial resolution, and will be combined with external portal imaging device data for full 3D volumetric video rate validation of treatments. The integration of specialized anatomic and motion body phantoms will round out the test product lines for this badly needed advance in radiotherapy. The software tool will allow the non-expert user to directly compare to the treatment plan, using standard gamma analysis conventions expected for verification. The work carried out in the company is augmented by a plan to evaluate the system in Clinical Physics at Dartmouth, and be further evaluated at Stanford, UPenn and WashU. The technology patent protected as developed by this group, and for this start up, the team of developers includes a substantial number of experts in Cerenkov imaging, medical physics and new venture creation.